Korean J Urol.  2014 Apr;55(4):239-244. 10.4111/kju.2014.55.4.239.

Relating Prognosis in Chromophobe Renal Cell Carcinoma to the Chromophobe Tumor Grading System

• Weinzierl
• Thong AE
• McKenney J
• Jeon SH
• Chung BI

• KMID: 1885603
• DOI: http://doi.org/10.4111/kju.2014.55.4.239

Abstract

PURPOSE
The chromophobe subtype of renal cell carcinoma (chRCC) has generally been associated with a better prognosis than the clear cell type; however, debate continues as to absolute prognosis as well as the significance of certain prognostic variables. We investigated the significance of pathologic stage and a recently proposed chromophobe tumor grading (CTG) scheme in predicting chRCC outcomes.
MATERIALS AND METHODS
All available chRCCs were identified from our surgical pathology archives from 1987-2010. Original slides were reviewed to verify diagnoses and stage, and each case was graded following a novel chromophobe tumor grade system criteria. Disease status was obtained from a clinical outcome database, and cancer specific deaths and recurrences were recorded.
RESULTS
Eighty-one cases of chRCC were identified, and 73 had adequate follow-up information available. There were only 3 instances of cancer related recurrence or mortality, which included 1 disease specific mortality and 2 disease recurrences. Pathologic stage and CTG 3 were found to be significantly associated with the recurrences or death from chRCC, but there was no association with CTG 1 and CTG 2.
CONCLUSIONS
chRCC is associated with a very low rate of cancer specific events (4.1%) even at a tertiary referral center. In our study, pathologic stage and CTG 3, but not CTG 1 or 2, were significantly associated with the development of these events.

Keyword

Nephrectomy; Prognosis; Renal cell carcinoma

MeSH Terms

Carcinoma, Renal Cell*
Diagnosis
Follow-Up Studies
Mortality
Neoplasm Grading*
Nephrectomy
Pathology, Surgical
Prognosis*
Recurrence
Tertiary Care Centers

Figure

• 

  FIG. 1 Chromophobe tumor grade (CTG) system with hematoxylin and eosin staining (A, ×1,500), classic CTG 1 ChRCC with abundant clear cytoplasm and prominent cell membranes (B, ×1,500), CTG 2 ChRCC characterized by a higher nuclear to cytoplasmic ratio compared to CTG 1 (C, ×3,000), at higher magnification CTG 2, ChRCC has a crowded cellular appearance but does not show the spindling or degree of diffuse anaplasia of CTG 3 (D, ×600). Grade 3 ChRCC with sarcomatoid differentiation characterized by an associated malignant spindle cell proliferation. ChRCC, chromophobe subtype of renal cell carcinoma.

Reference

1. Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B, et al. The Heidelberg classification of renal cell tumours. J Pathol. 1997; 183:131–133.

2. Thoenes W, Storkel S, Rumpelt HJ. Human chromophobe cell renal carcinoma. Virchows Arch B Cell Pathol Incl Mol Pathol. 1985; 48:207–217.

3. Crotty TB, Farrow GM, Lieber MM. Chromophobe cell renal carcinoma: clinicopathological features of 50 cases. J Urol. 1995; 154:964–967.

4. Amin MB, Amin MB, Tamboli P, Javidan J, Stricker H, de-Peralta Venturina M, et al. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol. 2002; 26:281–291.

5. Beck SD, Patel MI, Snyder ME, Kattan MW, Motzer RJ, Reuter VE, et al. Effect of papillary and chromophobe cell type on disease-free survival after nephrectomy for renal cell carcinoma. Ann Surg Oncol. 2004; 11:71–77.

6. Capitanio U, Cloutier V, Zini L, Isbarn H, Jeldres C, Shariat SF, et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int. 2009; 103:1496–1500.

7. Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML. Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol. 2003; 27:612–624.

8. Ficarra V, Martignoni G, Galfano A, Novara G, Gobbo S, Brunelli M, et al. Prognostic role of the histologic subtypes of renal cell carcinoma after slide revision. Eur Urol. 2006; 50:786–793.

9. Gudbjartsson T, Hardarson S, Petursdottir V, Thoroddsen A, Magnusson J, Einarsson GV. Histological subtyping and nuclear grading of renal cell carcinoma and their implications for survival: a retrospective nation-wide study of 629 patients. Eur Urol. 2005; 48:593–600.

10. Lee WK, Byun SS, Kim HH, Rha KH, Hwang TK, Sung GT, et al. Characteristics and prognosis of chromophobe non-metastatic renal cell carcinoma: a multicenter study. Int J Urol. 2010; 17:898–904.

11. Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, Blute ML, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol. 2010; 183:1309–1315.

12. Moch H, Gasser T, Amin MB, Torhorst J, Sauter G, Mihatsch MJ. Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer. 2000; 89:604–614.

13. Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A, et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol. 2005; 23:2763–2771.

14. Teloken PE, Thompson RH, Tickoo SK, Cronin A, Savage C, Reuter VE, et al. Prognostic impact of histological subtype on surgically treated localized renal cell carcinoma. J Urol. 2009; 182:2132–2136.

15. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982; 6:655–663.

16. Delahunt B, Sika-Paotonu D, Bethwaite PB, McCredie MR, Martignoni G, Eble JN, et al. Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. Am J Surg Pathol. 2007; 31:957–960.

17. Paner GP, Amin MB, Alvarado-Cabrero I, Young AN, Stricker HJ, Moch H, et al. A novel tumor grading scheme for chromophobe renal cell carcinoma: prognostic utility and comparison with Fuhrman nuclear grade. Am J Surg Pathol. 2010; 34:1233–1240.

18. Przybycin CG, Cronin AM, Darvishian F, Gopalan A, Al-Ahmadie HA, Fine SW, et al. Chromophobe renal cell carcinoma: a clinicopathologic study of 203 tumors in 200 patients with primary resection at a single institution. Am J Surg Pathol. 2011; 35:962–970.

19. Finley DS, Shuch B, Said JW, Galliano G, Jeffries RA, Afifi AA, et al. The chromophobe tumor grading system is the preferred grading scheme for chromophobe renal cell carcinoma. J Urol. 2011; 186:2168–2174.

20. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer;2010.

21. Ljungberg B, Alamdari FI, Stenling R, Roos G. Prognostic significance of the Heidelberg classification of renal cell carcinoma. Eur Urol. 1999; 36:565–569.

22. Thoenes W, Storkel S, Rumpelt HJ, Moll R, Baum HP, Werner S. Chromophobe cell renal carcinoma and its variants: a report on 32 cases. J Pathol. 1988; 155:277–287.

23. Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, et al. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol. 2007; 25:1316–1322.

24. Cheville JC, Lohse CM, Zincke H, Weaver AL, Leibovich BC, Frank I, et al. Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol. 2004; 28:435–441.

25. de Peralta-Venturina M, Moch H, Amin M, Tamboli P, Hailemariam S, Mihatsch M, et al. Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol. 2001; 25:275–284.